NPI | 1467873778 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 27495) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
103TH0004X Psychologist Health | |
103TF0000X Psychologist Family | |
103TP2701X Psychologist Group Psychotherapy | |
103TA0400X Psychologist Addiction (Substance Use Disorder) | |
Enumeration Date | 2014-01-05 |
Last Update Date | 2015-09-22 |